(Diagrammatic drawing of Anatomic hole (Myopectineal orifice

Anatomic hole located between the false pelvis and ipsilateral lower extremity

This is a weak area in the groin where posterior layer is not protected by overlying muscle

The myopectineal orifice is quadrangular in shape and is divided into a superior and inferior level by the inguinal ligament

Its role is to allow passage of the spermatic cord structures superiorly and the femoral vessels inferiorly

The boundaries of the myopectineal orifice are the arching fiber of the internal oblique superiorly, the rectus abdominis muscle medially, the anterior borders of the iliac bone inferiorly, and the iliopsoas and iliopectineal arch laterally

This anatomic hole can be further divided into 3 anatomic triangles (medial, lateral, and femoral), which are potential sites of groin herniation

The medial triangle is the space encircled by the arching fibers of the internal oblique superiorly, the rectus abdominis medially, the inguinal ligament inferiorly, and deep epigastric vessels laterally

This medial triangle within the myopectineal orifice is the site of direct herniation within the groin

The next anatomic triangle within the myopectineal orifice is the lateral triangle

The triangle is defined by the deep epigastric vessels medially, the inguinal ligament inferiorly, and a line drawn from the lateral inguinal ligament to the intersection of the deep epigastric vessels with the arching fibers of the internal oblique

The final triangle within the myopectineal orifice is the femoral triangle

Located in the inferior aspect of the myopectineal orifice, the area is bordered by the Cooper’s ligament inferiorly, the inguinal ligament and iliopubic tract superiorly, and iliopsoas muscle laterally

All groin hernias begin as a weak area in the myopectineal orifice

The transversalis fascia layer deteriorates and allows a peritoneal protrusion through it

Depending on the length of the insertion of the transversus abdominis on the Cooper's ligament, the presence of a patent processus vaginalis, and the size of the femoral ring, the hernia can be direct, indirect, femoral, or any combination of the three

Groin hernia can be corrected by either repairing all or part of this myopectineal orifice or by substituting a prosthesis for the deteriorated transversalis fascia